Research ArticlePrevalence and risk factors of non-alcoholic fatty liver disease in the elderly: Results from the Rotterdam study
Introduction
Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in Western countries in parallel with worsening epidemics of obesity and type II diabetes mellitus. NAFLD has been associated with an increased overall and cardiovascular mortality [1], [2], [3]. It has been projected that NAFLD will be the most common indication for liver transplantation in the next decades. In addition, global prevalence and impact of NAFLD are likely to increase as a result of population aging and increasing prevalence of obesity. Therefore, NAFLD constitutes a relevant public health issue.
The estimated prevalence of NAFLD in the adult general population ranges between 15% and 30% [4], [5], [6], [7], [8]. The prevalence of NAFLD appears to increase with age, especially through the fourth to sixth decade of life [9], [10]. In two large studies, based on cohorts of the Dallas Heart Study and Framingham Heart Study, participants with fatty liver were significantly older than participants without fatty liver [5], [6]. However, these studies only included a small number of participants older than 65 years. Prevalence and risk factors of NAFLD may vary in the elderly, as a result of metabolic changes at old age, including fat redistribution, and mitochondrial dysfunction [11], [12].
The association of obesity, diabetes, dyslipidemia, and insulin resistance with NAFLD has been extensively investigated in adult subjects [5], [6], [13], [14], [15], [16], [17]. These metabolic traits are now well-recognized risk factors for NAFLD. However, fewer data are available concerning the association of NAFLD with some environmental traits, including physical activity and smoking. Regarding the latter, studies have yielded contradictory results [18], [19].
The aim of this study was to determine the prevalence of NAFLD in an elderly population and to generate insight into the association of NAFLD with metabolic risk factors, smoking, physical activity, and markers of liver injury.
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Study population
The Rotterdam Study is a large prospective population-based cohort study conducted among elderly inhabitants of Ommoord, a district of Rotterdam, The Netherlands. The rationale and study design had been previously described [20]. The medical ethics committee at Erasmus University of Rotterdam approved the study, and written informed consent was obtained from all participants.
Abdominal ultrasonography was added to the core protocol at the fifth survey of the Rotterdam Study (February
Study population
A total of 3205 participants underwent abdominal ultrasonography. Three hundred ninety-four participants were excluded (excessive alcohol consumption (n = 255), positive HBsAg (n = 3) or anti-HCV (n = 24), use of pharmacological agents historically associated with fatty liver (n = 121)). The total number of eligible study participants was 2811.
General characteristics are shown in Table 1. Sixty percent of the study population consisted of women. Mean age of participants was 76.4 ± 6.0 years (range
Discussion
The present study demonstrated that NAFLD was prevalent in more than one-third of the elderly and showed strong association with metabolic traits, including abdominal obesity, dyslipidemia, and impaired fasting glucose. Furthermore, we observed a decreasing prevalence of NAFLD with advancing age, suggesting a positive selection of the elderly without NAFLD.
This is the first large population-based study to describe the prevalence of, and risk factors for NAFLD in the elderly. Although several
Financial support
The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII) and by the Municipality of Rotterdam.
This study was financially
Conflict of interest
The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Acknowledgements
The authors thank the Rotterdam Study participants and the Rotterdam Study team; they also thank Pauline van Wijngaarden for her assistance in data collection.
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